1997 Naafa Cherry Hill Convention Monica

Foreword

"In 1986, an NIH consensus . . ." Ernsberger, P. NIH consensus conference on obesity: by whom and for what? J Nutr. 1987; 117:1164-1165.

"It did so despite presentations . . ." Andres, R., Muller, D.C., Sorkin, J.D. Long-term effects of change in body weight on all-cause mortality. A review. Ann Intern Med. 1993; 119:737-743.

"This idea did not catch on at the time . . ." NIH Tech Assess Conf Panel. Methods for voluntary weight loss and control. Ann Intern Med. 1993; 119:764-770.

"The fen-phen craze was triggered . . ." Weintraub, M., Sundaresan, P.R., Ma-dan, M., Schuster, B., Balder, A., Lasagna, L., Cox, C. Long-term weight control study. I (weeks 0 to 34). The enhancement of behavior modification, caloric restriction, and exercise by fenfluramine plus phentermine versus placebo. Clin Pharmacol Ther. 1992; 51:586- 594.

"Editorials by obesity experts duly appeared . . ." Bray, G.A. Use and abuse of appetite-suppressant drugs in the treatment of obesity. Ann Intern Med. 1993; 119: 707-713.

"When I arrived to testify at the FDA hearing . . ." Ernsberger, P., Koletsky, R.J., Kilani, A., Viswan, G., Bedol, D.. Effects of weight cycling on urinary cate-cholamines: sympathoadrenal role in refeeding hypertension. J Hypertens. 1998; 16:2001-2005. Ernsberger, p., Koletsky, R.J., Baskin, J.Z., Collins, L.A. Consequences of weight cycling in obese spontaneously hypersensitive rats. Am J Physiol. 1996; 270:R864-R872. Ernsberger, P., Koletsky, R.J. Weight cycling. JAMA. 1995; 273:998-999.

"Indeed, long-term human studies show . . ." Lissner, L., Odell, P.M., D'Agos-tino, R.B., Stokes, J., III, Kreger, B..E, Belanger, A.J., Brownell, K.D. Variability of body weight and health outcomes in the Framingham population. N Engl J Med. 1991;324:1839-1844.

Chapter 1

" 'Let's look at a threat that is very real . . .' " "Obesity Is America's Greatest Threat, Surgeon General Says," Orlando Sentinel, January 22, 2003, p. B1.

"From C. Everett Koop . . ." The Dallas Morning News, April 8, 2001, p. 1J. For Satcher's views on obesity, see The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (2001).

"Medical researchers have gone so far as to . . ." For a recent suggestion by a prominent obesity researcher that certain foods be taxed, see "Cancer Group Tries to Link Fat, Cancer in Public Mind," www.cnn.com/2003/HEALTH/diet.fitness/ 02/19cancer.weigh.in.ap/index.html (accessed February 23, 2003).

" 'A strong international consensus among scientists . . .' " The New Republic, February 15, 2003 (letter).

" '[L]ike a bad case of the flu.' " Greg Critser, "Let Them Eat Fat," Harper's, March 2000, p. 42.

"According to Yale Medical School professor Kelly Brownell . . ." Boston Globe, May 29, 2003, p. A13.

" 'Adults should try to maintain a body mass index between 18.5 and 21.9 . . .' "

Field et al. "Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period," Arch Intern Med 161, 1581-86 (2001).

"Many of the most prominent figures in obesity research have direct ties . . ." For a detailed discussion of the links between obesity researchers and the weight loss industry, see Laura Fraser, Losing It: False Hopes and Fat Profits in the Diet Industry (1998), pp. 209-33.

"These surgeries remain both highly profitable and extremely dangerous . . ." "Almost 2% of the patients undergoing gastric bypass surgery for morbid obesity will die within the first 30 days, according to a report presented October 21st [2003] at the American College of Surgeons 2003 Clinical Congress." Abstract from the ACS 2003 Clinical Congress.

"As University of Virginia professor Glenn Gaesser points out . . ." Glenn Gaesser, Big Fat Lies: The Truth About Your Weight and Your Health (2002), pp. 44-51.

"Anti-fat warriors still cite the insurance charts . . ." See, for example, Michael Fumento, "Quit Living in the Fat Lane," Washington Times, June 30, 2002, p. B-5. Fumento's obsession with the supposedly deadly effects of "excess" weight, illustrated by his voluminous journalism on the subject, is a particularly interesting example of the distorting effects this topic has on many media figures. In other contexts, Fumento has been at the forefront of those who denounce the distortion of public health information and agendas by ideological factors. For instance, his book The Myth of Heterosexual AIDS exposed how statistics are manipulated by government agencies to foment concern about a largely imaginary "epidemic." More recently, his writings regarding the panic over SARS have struck the same note. Yet when the subject is fat, the very same agencies that Fumento elsewhere treats with well-warranted skepticism are presented to readers as if they were infallible sources of objective scientific knowledge.

"Here are some figures from what at the time it was compiled was the world's largest epidemiological study to date." Waaler et al., "Height, Weight and Mortality: The Norwegian Experience, Acta Med Scanda Suppl 679, 1-56 (1984).

"In the late 1980s, obesity researchers Paul Ernsberger and Paul Haskew undertook a comprehensive review . . ." Ernsberger and Haskew, "Health Implications of Obesity: An Alternative View," J Obesity W Reg 6, 67 (1987).

"A particularly compelling illustration of this point is provided by a 1996 study . . ." Troiano et al., "The Relationship Between Body Weight and Mortality: A Quantitative Analysis of Combined Information from Existing Studies," Int J Obesity 20, 63-75 (1996).

"For instance, the Pooling Project . . ." McGee and Gordon, "The Results of the Framingham Study Applied to Four Other U.S.-based Epidemiological Studies of Cardiovascular Disease," in The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease, NIH Publication #76-1083 (1976).

"Another compelling example is provided by the NHANES I survey . . ." Durazo-Arvizu et al., "Mortality and Optimal Body Mass Index in a Sample of the U.S. Population," Am J Epidemiol 147, 739-49 (1998).

"Yet another example comes from the famous Seven Countries Study . . ." Menotti et al., "Underweight and Overweight in Relation to Mortality Among Men Aged 40-49 and 50-59 Years: The Seven Countries Study, Am J Epidemiol 151, 660-66 (2000).

"Let us look at four of the most cited studies for the proposition that 'overweight' is a deadly epidemic . . ." Manson et al., "Body Weight and Mortality Among Women," N Engl J Med 333, 677-82 (1995); Allison et al., "Annual Deaths Attributable to Obesity in the United States," JAMA 282, 1530-1538 (1999); Fontaine et al., Years of Life Lost to Obesity," JAMA 289, 187-197 (2003); Calle et al., "Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults," New Engl J Med 348, 1625-38 (2003).

"This range includes most of the people the government now classifies as overweight and obese." For current weight levels across the U.S. population see Flegall et al., "Prevalence and Trends in Obesity Among U.S. Adults, 1999-2000," JAMA 288, 1723-32 (2002).

"Even massively obese men and women do not appear to be more prone to vascular disease than average." Chambless et al., "Risk Factors for Progression of Common Carotid Atherosclerosis: The Artherosclerosis Risk in Communities Study, 1987-1998," Am J Epidemiol 155, 38-47 (2002).

"But even here there is considerable evidence that this correlation is not necessarily a product of being fat . . ." See Gaesser, Big Fat Lies, pp. 59-74.

"Obese patients who have been put on very low-calorie diets . . ." Drenick et al., "Excessive Mortality and Causes of Death in Morbidly Obese Men," JAMA 243, 443-45 (1980).

"When the siege of Leningrad was lifted . . ." Ancel Keys et al., Biology of Human Starvation (1950).

"Among those who suffer from hypertension the mortality rate from the disease is two to three times lower among heavier individuals . . ." Taminga and Yoshiba, "Prognosis of Essential Hypertension: Four-year Follow-up Study of 416 Consecutively Admitted Patients," Jap Circ J 31, 55-59 (1967).

"Glenn Gaesser points out the potentially deadly irony . . ." Gaesser, Big Fat Lies, p. 62.

"Despite the obesity epidemic, these trends are continuing with no end in sight." New York Times, January 19, 2003, Sec. 1, p. 1. See also Keys, "Is There an Ideal Body Weight?" Brit Med J 293, 1023-24 (1986).

"Several recent studies indicate that the key to avoiding Type 2 diabetes is . . . to make lifestyle changes . . ." Lamarche et al. "Is Body Fat Loss a Determinant Factor in the Improvement of Carbohydrate and Lipid Metabolism Following Aerobic Exercise Training in Obese Women?" Metabolism 41, 1249-56 (1992); Barnard et al., "Diet and Exercise in the Treatment of NIDDM," Diabetes Care 17, 1469-72 (1994); Tuomilehto et al., "Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle Among Subjects with Impaired Glucose Tolerance," New Engl J Med 344, 1343-50 (2001); Diabetes Prevention Program Research Group, "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin," New Engl J Med 346, 393-403 (2002).

"Over the past three decades, according to Glenn Gaesser's survey of the literature . . ." For examples see Kabat and Wynder, "Body Mass Index and Lung Cancer Risk," Am J Epidemiol 135, 769-74 (1992); Kabat, "Aspects of the Epidemiology of Lung Cancer in Smokers and Non-Smokers in the United States," Lung Cancer 15, 1-20 (1996); Avons et al. "Weight and Mortality," Lancet 1983, 1104 (1983); van De Brandt et al. "Pooled Analysis of Prospective Studies on Height, Weight and Breast Cancer Risk," Am J Epidemiol 152, 514-27 (2000); Keys et al., "Serum Cholesterol and Cancer Mortality in the Seven Countries Study," Am J Epidemiol 121, 870-883 (1985). See generally, Gaesser, Big Fat Lies, at 99-102. See also Menotti, cited above.

"Other studies have shown that heavier people are less prone to suffer from cancer . . ." Nomura et al., "Body Mass Index as a Predictor of Cancer in Men, J Nat Cancer Inst 74, 319-23 (1985); Lee and Kolonel, "Are Body Mass Indicies Interchangeable in Measuring Obesity-Disease Associations?" Am J Publ Hlth 74, 376-77 (1984); Garcia-Palmieri et al., "An Apparent Inverse Relationship Between Serum Cholesterol and Cancer Mortality in Puerto Rico," Am J Epidemiol 114, 29-44 (1981).

"Diseases and syndromes that various medical studies indicate are less common among heavier people include . . ." Comstock et al., "Subcutaneous Fatness and Mortality," Am J Epidemiol 83, 548-63 (1966); Krieger et al., "An Epi-demiologic Study of Hip Fracture in Postmenopausal Women," Am J Epidemiol 116, 141-48 (1982); Kauffmann and Brille, "Bronchial Hypersecretion, Chronic Airflow Limitation, and Peptic Ulcer," Am Rev Resp Dis 124, 646-49 (1981); Hooy-man et al., "Fractures from Rheumatoid Arthritis: A Population-Based Study," Arth Rheumatism 27, 1353-61 (1984); Tverdal, "Body Mass Index and Incidence of Tuberculosis," Eur J Resp Dis 69, 355-62 (1986).

"How many people are aware that heavier women have much lower rates of osteoporosis . . ." Avioli, "Significance of Osteoporosis: A Growing International Health Care Problem," Calcif Tissue Int 49, S5-S7 (1991); Edelstein and Barrett-Connor, "Relation Between Body Size and Bone Mineral Density in Elderly Men and Women," Am J Epidemiol 138, 160-69 (1993); Tremollieres et al., "Vertebral Postmenopausal Bone Loss Is Reduced in Overweight Women: A Longitudinal Study in 155 Early Postmenopausal Women," J Clin Endocrinol Metab 77, 683-86 (1993).

" 'Epidemiology is a crude and inexact science . . .' " New York Times, October 11, 1995, Sec. C, p. 1.

"To understand the implications of this distinction, consider the fact that bald men die sooner . . ." This analogy was suggested to me by Paul Ernsberger.

"The standard 'sensible' recommendations to change eating habits and diligently use caloric charts . . .' " Bennett and Gurin, The Dieter's Dilemma (1982), p. 283.

"The vast majority of people who attempt to lose weight eventually gain all the weight they lose back." For a recent article illustrating the extent to which dieting is a significant predictor of future weight gain, see Korkeila et al., "Weight Loss

Attempts and Risk of Major Weight Gain: A Prospective Study in Finnish Adults," Am J Clin Nutr 70, 965-75 (1999). See also Garner and Wooley, "Confronting the Failure of Behavioral and Dietary Treatments for Obesity," Clin Psychol Rev 11, 729-80 (1991).

"More Americans than ever are dieting . . ." Serdula et al., "Prevalence of Attempting Weight Loss and Strategies for Controlling Weight,"JAMA 282, 1353-58 (1999).

"Yet Glenn Gaesser notes that numerous studies . . ." Gaesser, Big Fat Lies, pp. 131-45.

"In the early 1990s, a major American Cancer Society study . . ." Pamuk et al., "Weight Loss and Mortality in a National Cohort of Adults, 1971-1987," Am J Epidemiol 136, 686-97 (1992); Pamuk et al., "Weight Loss and Subsequent Death in a Cohort of U.S. Adults," Ann Int Med 119, 744-48 (1993).

"A 1999 report based on the same data pool . . ." Williamson et al., "Prospective Study of Intentional Weight Loss and Mortality in Overweight White Men Aged 40-64 Years," Am J Epidemiol 149, 491-503 (1999).

"The only other large study to look into the question of the health effects of intentional weight loss . . ." French et al., "Prospective Study of Intentional Weight Loss and Mortality in Older Women: The Iowa Women's Health Study," Am J Epidemiol 149, 504-14 (1999).

"In Steven Blair's ongoing long-term longitudinal study . . ." Blair et al., "Body Weight Change, All-Cause Mortality, and Cause-Specific Mortality in the Multiple Risk Factor Intervention Trial," Ann Int Med 119, 749-57 (1993).

"In the ongoing Harvard Alumni Study . . ." Lee and Paffenbarger, "Change in Body Weight and Longevity," JAMA 268, 2045-49 (1992).

"A recent article in a magazine published by the American Association of Retired Persons . . ." See www.aarpmagazine.com/march-april.html (accessed February 24, 2003).

"Such recommendations fly in the face of a host of recent studies . . ." Wedick et al., "The Relationship Between Weight Loss and All-Cause Mortality in Older Men and Women with and Without Diabetes Mellitus: The Rancho Bernardo Study," J Am Geriatr Soc 50, 1810-15 (2002); Soames et al., "Body Mass Index, Weight Change, and Death in Older Adults: The Systolic Hypertension in the Elderly Program," Am J Epidemiol 156, 132-38 (2002); Newman et al., "Weight Change in Old Age and Its Association with Mortality," J Am Geriatr Soc 49, 1309-18 (2001); Singh et al., "The Effect of Menopause on the Relation Between Weight Gain and Mortality Among Women," Menopause 8, 314-320 (2001); Milne et al., "Protein and Energy Supplementation in Elderly People at Risk from Malnutrition," Cochrane Database Syst Rev CD003288 (2002).

". . . studies that indicate weight cycling is a major factor in . . . serious health problems." Hamm et al., "Large Fluctuations in Body Weight During Young Adulthood and Twenty-five Year Risk of Coronary Death in Men," Am J Epidemiol 129, 312-18 (1989); Iribarren et al., "Association of Weight Loss and Weight Fluctuation with Mortality Among Japanese American Men," New Engl J Med 333, 686-92 (1995); Lissner et al., "Body Weight Variability and Mortality in the Gothenburg Prospective Studies of Men and Women," in Obesity in Europe, Bjorntorp and Rossner, eds., pp. 55-60 (1989); Brownell and Rodin, "Medical, Metabolic, and Psychological Effects of Weight Cycling," Arch Int Med 154, 1325-31 (1994).

"Dieters as a group run up to double the risk of developing cardiovascular disease . . ." Gaesser, Big Fat Lies, p. 19.

"Indeed, the more often a person diets, the stronger these cravings become."

Drewnowski and Holden-Wiltse, "Taste Responses and Food Preferences in Obese Women: Effects of Weight Cycling," Int J Obesity 16, 639-48 (1992).

". . . visceral body fat, which is far more dangerous to health than subcutaneous fat." Bouchard et al., "Genetic and Non-Genetic Determinants of Regional Fat Distribution," Endocrine Rev 14, 72-93 (1993).

"As Glenn Gaesser has pointed out, given what we know about relative rates of dangerous weight loss practices . . ." "Body Fat and Health: Conventional Wisdom vs. the Evidence," Keynote Speech, 2001 NAAFA Convention, August 14, 2001, Cherry Hill, NJ.

"The list of side effects from the most popular diet drugs is long." See Ernsberger and Haskew, cited above.

"A new Yale University study . . ." Kernan et al., "Phenylpropanolamine and the Risk of Hemorrhagic Stroke," New Engl J Med 343, 1826-32 (2000).

"Recently four prominent athletes . . ." "Ephedra Controversy Nothing New in Sports; Dietary Supplement Linked to Other Deaths," Washington Post, February 20, 2003, D4.

"After the FDA hearing at which its approval was temporarily blocked . . ."

"Obesity Drug; After Bitter 9-Hour Debate, FDA Panel's Ruling Still Awaited," Chicago Tribune, September 29, 1995, A15.

". . . a highly publicized study authored by June Stevens and others . . ." Stevens et al, "The Effect of Age on the Association Between Body-Mass Index and Mortality," New Engl J Med 338, 1-7 (1998).

". . . a Cooper Institute study published in JAMA . . ." Blair et al., "Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women," JAMA 262, 2395-2401 (1989).

"Similarly, a 1999 Cooper Institute study . . ." Lee et al., "Cardiorespiratory Fitness, Body Composition, and All-Cause and Cardiovascular Disease Mortality in Men," Am J Clin Nutr 69, 373-80 (1999).

"A 1995 Blair study found . . ." Barlow et al., "Physical Fitness, Mortality and Obesity," Int J Obesity 19, S41-S44 (1995).

"As Blair himself puts it . . ." "Exercise Benefits Even Obese People," Associated Press Wire Story, July 18, 2001.

"Ralph Paffenbarger's Harvard Alumni Study . . ." Paffenbarger et al., "Physical Activity, All-Cause Mortality, and Longevity of College Alumni," New Engl J Med 314, 605-13 (1986).

"The Behavioral Risk Factor Surveillance System . . ." Hahn et al., "Cardiovascular Disease Risk Factors and Preventive Practices Among Adults—United States, 1994: A Behavioral Risk Factor Atlas," MMWR 47, 35-72 (1998).

"And a 2002 study of nearly ten thousand Puerto Rican men . . ." Crespo et al., "The Relationship of Physical Activity and Body Weight with All-Cause Mortality: Results from the Puerto Rico Heart Health Program," AEP 12, 543-52 (2002).

"Indeed whether people are active or sedentary . . ." A host of studies suggest that both preexisting differences in activity levels and subsequent changes to such levels have almost no relevance to variances in body mass. For example, a ten-year study of American adults found no relationship between baseline physical activity and later weight gain among men and women. See Williamson, et al., "Recreational Physical Activity and Ten-Year Weight Change in a US National Cohort," Int J Obesity 17, 279-86 (1993). A recent study of nearly forty thousand female health professionals found that the average weight variance between the most sedentary and the most active women was about 1.5 BMI units, i.e., about 7 pounds. See Lee et al., "Physical Activity and Coronary Heart Disease in Women," JAMA 285, 1447-54 (2001). A Harvard Alumni Study of more than twelve thousand men found essentially no weight difference between highly sedentary men who expended less than 500 calories per week in exercise activities, and extremely active men who expended more than 3,000 calories per week (the average BMIs of the two groups were 24.7 and 24.4 respectively). See Sesso et al., "Physical Activity and Coronary Heart Disease in Men," Circulation 102, 975-80 (2000). And a new study measuring the effects of a sixteen-month exercise regimen (2,000 calories per week) on overweight and obese women observed an average total weight loss of 1 pound, i.e., one ounce per month, among those women who did not drop out of the program. See Donnelley et al., "The Midwest Exercise Trial," Arch Int Med 163, 1343-50 (2003).

"In short, as Glenn Gaesser points out . . ." Big Fat Lies, p. 117.

For a few representatives of the extremely extensive literature questioning the case against fat, see, for example, Gaesser, Big Fat Lies, cited above; Ernsberger and Haskew, cited above; Keys, Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease (1980); Andres, "Beautiful Hypotheses and Ugly Facts: The BMI-Mortality Association," Obesity Res 7, 417-19 (1999); Hilda Bruch, Eating Disorders (1974); Blair, articles cited above; Barrett-Conner, "Obesity, Atherosclerosis, and Coronary Artery Disease," Ann Int Med 103, 1010-19 (1985); Polivy and Herman, Breaking the Diet Habit (1993); S. Wooley and O. Wooley, "Should Obesity Be Treated at All?" in Eating and Its Disorders, Stunkard and Stellar, eds. (1984); Wooley and Garner, "Obesity Treatment: The High Cost of False Hope," J Am Diet Assoc 91, 1248-51 (1991); Ikeda et al., "A Commentary on the New Obesity Guidelines from NIH," J Am Diet Assoc 99, 918-19 (1999); Kim Chernin, The Obsession (1981); Hillel Schwartz, Never Satisfied: A Cultural History of Diets, Fantasies and Fat (1986); Roberta Seid, Never Too Thin: Why Women Are at War with Their Bodies (1989); Richard Klein, Eat Fat (1996); Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body (1995); Laura Fraser, Losing It, cited above; Naomi Wolf, The Beauty Myth (1991); Susie Orbach, Fat Is a Feminist Issue (1978).

"In his book The Culture of Fear . . ." Barry Glassner, The Culture of Fear: Why Americans Are Afraid of the Wrong Things (1999), pp. xxvi-xxviii.

Chapter 2

"However, there is still a fifty-billion-dollar-per year industry . . ." For one calculation of the size of the American diet industry, see Fraser, Losing It, p. 299. The figure could be considerably higher if one were to include items such as workout equipment, subscriptions to magazines such as Shape and the like, that are largely devoted to weight loss, etc.

"Basically, obesity research in America is funded by the diet and drug industry . . ." See Fraser, Losing It, pp. 209-32 for a detailed discussion of the economics of obesity research.

"The last sentence in this hypothetical abstract illustrates what dissident obesity researcher Susan Wooley . . ." For a good summary of Wooley's views, see Wooley and Garner, "Obesity Treatment: The High Cost of False Hope," J Am Diet Assoc 91, 1248-51 (1991).

"My favorite is a recent study that concludes the majority of weight variance is unalterably genetic . . ." Allison and Pi-Sunyer, "Fleshing Out Obesity," The Sciences, May-June 1994, 38-43.

"This is in fact a fairly accurate description of the United States during the last few decades of the nineteenth century . . ." For discussions of changing standards of beauty in American culture, see Hillel Schwartz, Never Satisfied: A Cultural History of Diets, Fantasies and Fat (1986); Roberta Seid Never Too Thin: Why Women Are at War with Their Bodies (1989). For information on Lillian Russell, see Parker Morell, Lillian Russell: The Era of Plush (1940).

"In West Africa today, beauty pageants feature contestants that would be considered markedly 'obese' . . ." See "Bigger Is Better at 'Miss Fat South Africa' Beauty Pageant," Jet, May 20, 2002, p. 55.

"When one considers the extent of the damage done by the eating disorders from which at least eight million Americans currently suffer . . ." For current statistics on eating disorders in America, see the National Association for Anorexia Nervosa and Associated Disorders website, at www.anad.org.

Chapter 3

"The cover of the March 2000 issue of Harper's . . ." Critser has since expanded his thoughts on this issue into a book, Fat Land, that argues for a new appreciation of "the sin of gluttony." I agree with Critser that Americans have good reasons to be concerned about overconsumption in our society. The question, however, is whether the fact that Americans gained an average of 8 pounds over the course of the 1990s has as much political, environmental, and ethical significance as such facts as that our automobiles gained an average of several hundred pounds during those years.

"This essay is in many ways representative of the sort of reportage regarding weight-related issues now appearing on a daily basis . . ." A search of the Nexis database for articles published in major English-language newspapers reveals that, as of September 2003, the claim that fat kills three hundred thousand Americans per year had appeared in more than 1,700 stories over the past two years alone.

"An outbreak of influenza in 1918 killed between twenty and forty million people . . ." See Alfred Crosby's America's Forgotten Pandemic: The Influenza of 1918 for an account of a real epidemic, and the genuine public health crisis it engendered.

"They will never be given a hint of the fact that, in the words of the editors of The New England Journal of Medicine . . ." See Jerome Kassirer and Marcia Angell, "Losing Weight—An Ill-Fated New Year's Resolution," New Engl J Med 338, 52-54 (1998).

"Even quite fat people have better health, on average, than fashionably thin women." See the epidemiological studies cited in the notes to Chapter 1. Almost invariably, people with BMI figures below 18.5 have shorter average life expectancies than people with BMI figures in the mid-30s. (An average-height woman with a BMI of 18 weighs 106 pounds; a woman of the same height with a BMI of 35 weighs 202 pounds.) Nearly all fashion models, and most prominent actresses, have BMI figures below 18.5. Obesity researchers try to explain away such awkward facts, when they address them at all, by assuming reverse causation in regard to thinness and ill health, and direct causation in regard to fatness and ill health. In other words, they assume that thin people are thin because they are sick, and that fat people are sick because they are fat. Yet the correlation (unusually thin people not living as long as quite fat people) remains even when researchers go to great lengths to exclude already-sick individuals from their data pools, by, for example, excluding from the study's data everyone who dies within a year or two of entering the study.

"At bottom, journalists tend to believe what they believe about fat because what they believe about fat simply reflects the views about fat held by the people they know best . . ." For liberal and conservative accounts of how the ethnography of journalism affects the framing of public issues, see, respectively, Martin Lee and Norman Solomon, Unreliable Sources: A Guide to Detecting Bias in News Media (1990), and Brent Bozell and Brent H. Baker, And That's the Way It Isn't: A Reference Guide to Media Bias (1990).

"Recent news reports indicate that fat anxiety is becoming common among six- to eight-year-olds . . ." This anxiety is soon transformed into action. Nearly half of all nine- to eleven-year-old American girls report they are "sometimes or very often" on a diet, and more than half report they feel better about themselves when they are dieting. See "Smaller and Smaller: Eating Disorders Are Now Striking Younger Girls," Providence Journal-Bulletin February 16, 2003. In November 2003, the 12-year-old daughter of a colleague performed an experiment at two Boulder supermarkets. Naturally slim, she donned a (very convincing) "fat suit" to solicit donations for the Humane Society while "obese," and then did so again at her natural weight. In each of the four trials, she solicited the donations until exactly 100 people had walked by. She collected a total of $41.05 while thin, and $5.30 while fat.

"In his book The Anatomy of Disgust. . ." William Ian Miller, The Anatomy of Disgust (1997), p. 36.

"Studies investigating the relationship between weight and health among African American women have found no correlation between increasing weight and mortality among such women . . ." See, for example, Wienpahl et al., "Body Mass Index and 15-year Mortality in a Cohort of Black Men and Women," J Clin Epidemiol, 43, 949-60 (1990). See also Fontaine et al., "Years of Life Lost to Obesity," cited in the notes to Chapter 1.

"In his studies of the comparative development of cultures, Jared Diamond . . ." See Jared Diamond, Guns, Germs and Steel: The Fates of Human Societies (1999).

Chapter 4

"Indeed, to utter the word 'fat' has become arguably more transgressive . . ."

The semantics of the war on fat are significant in themselves. Those who wish to treat fat as a disease assiduously avoid the word, preferring instead to refer to "obesity" or "overweight." In theory, "obesity" could be a neutral descriptive term, defining a particular level of body mass; in practice, it has come to be synonymous with what is defined as a pathological condition. That is why fat activists insist on using the word "fat," which they want to see treated in the same way we treat terms such as "brown-haired" or "freckled." See, for example, Marilyn Wann, Fat!So? (1998) at 18: "When you claim the word fat, no one can use it against you ever again."

"Between the many varieties of vegetarianism . . ." See Anthony Bourdain, Kitchen Confidential: Adventures in the Culinary Underbelly (2001).

"The reason we are getting fatter while eating less fat is that, as Richard Klein points out . . ." See generally, Richard Klein, Eat Fat (1996). Relative caloric percentages from fat are taken from the United States Department of Agriculture statistics. See the USDA's website at www.usda.gov.

"Surveys indicate that dieters . . ." For statistics on the number of Americans who are currently trying to lose or not gain weight, see Serdula et al., "Prevalence of Attempting Weight Loss and Strategies for Controlling Weight,"JAMA 282, 1353-58 (1999).

"We are a nation of dieters, and therefore a nation of snackers . . ." For a discussion of the so-called French paradox (France has one-quarter the obesity rate of the United States, despite a much higher-fat diet) see Rozin et al., "The Ecology of Eating," Psychol Sci 14, 450 (2003).

"Laura Fraser describes the phenomenon well . . ." See Fraser, Losing It, pp. 118-19.

Chapter 5

"The obituary itself is a fascinating document . . ." See New York Times, June 5, 2000, Section A, p. 27.

"Consider the implications of the fact that several studies have found that short men . . ." See Allebeck et al., "Height, Body Mass Index, and Mortality: Do Social Factors Explain the Association?" Public Health 106 375-82 (1992); Peck and Vagero, "Adult Body Height, Self-perceived Health and Mortality in the Swedish Population," J Epidemiol 43, 380-84 (1984).

"Race and obesity both illustrate how the social effects of an idea can be very real . . ." Perhaps the most interesting parallel to early twenty-first-century obesity studies is provided by mid-nineteenth-century phrenology. Phrenologists operated on the basis of a fundamentally mistaken theory about the meaningfulness of variations in cranial features. Nevertheless, phrenology was for many decades an eminently respectable science, which produced learned journals, scholarly conferences, and endowed professorships. The decline of the field, in the face of evergrowing amounts of empirical disconfirmation, was slowed by the—sometimes explicit but more often implicit—belief that it simply wasn't possible that a well-organized form of scientific knowledge could be based on a fundamental theoretical mistake. See Pierre Schlag, "Law and Phrenology," Harvard Law Rev, 110, 887 (1997).

"According to Tony Gardner . . ." See The New Yorker, "Thy Neighbor's Fat Suit," July 16, 2001, p. 28.

"Paltrow's own experiences while making the film are revealing." See The Edmonton Sun, "Paltrow Puts Hollywood Obsessions to the Test," November 4, 2001, p. SE5.

"A recent essay in the New Yorker . . ." See "Thy Neighbor's Fat Suit," cited above.

"Researchers point out (correctly) that fat people face discrimination . . ." An excellent summary of the available research on discrimination against fat people is Puhl and Brownell, "Bias, Discrimination, and Obesity," Obesity Res 9, 788-805. Kelly Brownell's evident empathy for the deep discrimination fat people face has not stopped him from making the quest to turn fat people into thin people the prime focus of his work. See, for example, his book Food Fight (2003).

"One University of Arizona study found . . ." Parker et al., "Body Images and Weight Concerns Among African-American and White Adolescent Females," Human Org 54, 103-114 (1995).

"Is it a coincidence that black women are both far less obsessed with weight than white women . . ." See, for example, Dacosta and Wilson, "Food Preferences and Eating Attitudes in Three Generations of Black and White Women," Appetite (1999), at 183-91; Greenberg and Laporte, "Racial Differences in Body Type Preferences of Men and Women," J Eating Dis 19, 275-78 (1996).

"In recent years, companies such as Weight Watchers and Jenny Craig . . ." Fraser, Losing It, p. 142-43.

"As for obesity researchers, a recent article noted that black girls have better body images . . ." Kemper et al., "Black and White Females' Perceptions of Ideal Body Size and Social Norms," Obesity Res, 2, 117-25 (1994).

Chapter 6

"Studies indicate that, when women are asked to estimate the dimensions of their hips and thighs . . ." Ben-Touim et al., "Body Size Estimates: Body Image or Body Attitude Measures," Int J Eating Dis 9, 57-67 (1990); Galgan and Mable, "Body Satisfaction in College Women: A Survey of Facial and Body Size Components," Coll Student J 20, 326-28 (1986).

"Interestingly, some of the studies that indicate women consistently overestimate their actual body size also suggest men prefer women . . ." Jacobi and Cash, "In Pursuit of the Perfect Appearance: Discrepancies Among Self-Ideal Precepts of Multiple Physical Attributes," J Appl Soc Psychol 24, 379-96 (1994).

"Where, I wonder, are the mainstream feminist organizations . . ." See Chapter Seventeen for a discussion of the feminist movement's mixed record movement on issues of body oppression.

"Yet his campaign advisers emphasized to him that he needed to lose 30 pounds . . ." A recent New Yorker profile of Gore illustrates how we are becoming increasingly sensitive to superficial issues of appearance when evaluating political figures: "[The crowd] took turns speculating about what clues they'd soon be called upon to interpret. Beard or no beard? Earth tones or dark suit? Fat or thin?" "Impressions of Gore," New Yorker, August 18, 2003, p. 42.

"All other things being equal, it is probably healthier for an average-height woman to weigh 135 rather than 115 pounds . . ." For white women, the low point in the mortality curve tends to be at around a BMI of 24 (140 pounds for an average-height woman). For African American women, the lowest mortality point correlating with weight is about 15 to 20 pounds higher than that. See the studies cited in Chapter 1 for examples.

"There is nothing unusual about these hypothetical examples: as we shall see . . ." See Chapter 14 for a discussion of medical studies demonstrating that exactly the same levels of caloric intake and physical activity lead to vast differences in body mass among different individuals.

Chapter 7

For further details regarding Anamarie Regino's family's battle with New Mexico's public health and legal systems, see "Growing Pains," Denver Post, August 5, 2001, p. I-01; "Watching Her Weight," New York Times, July 8, 2001, at Sec. 6, p. 30; "Feeling Betrayed," Dallas Morning News, April 19, 2001, p. 1A; "Parents of Obese Child Say State Abused Its Power by Taking Custody," St. Louis Post-Dispatch, February 4, 2001, p. 3A; "Adela Martinez and Margaret Martinez Talk About Anamarie Regino's Obesity," ABC News, Good Morning America, June 18, 2001 (transcript).

Chapter 8

"Unfortunately, in modern American journalism, even the best regarded media sources . . ." For example, between September of 2001 and September of 2003, the supposed "fact" that fat kills three hundred thousand Americans per year was cited more than 1,700 times in the major English-language media, in the face of numerous demonstrations that this claim is at best a wild exaggeration, if not a completely spurious piece of junk science.

"Given this, consider the implications of the following piece of reportage . . ."

"Study Finds Diet, Exercise and Drug Prevent Diabetes," Wall Street Journal, August 8, 2001, p. 1.

"The study followed more than three thousand volunteers for at least three years." Tuomilehto et al., "Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle Among Subjects with Impaired Glucose Tolerance," New Engl J Med 344, 1343-50 (2001). For other studies indicating that lifestyle changes rather than weight loss per se are key to preventing and treating Type 2 diabetes, see Lamarche et al., "Is Body Fat Loss a Determinant Factor in the Improvement of Carbohydrate and Lipid Metabolism Following Aerobic Exercise Training in Obese Women?" Metabolism 41, 1249-56 (1992); Barnard et al., "Diet and Exercise in the Treatment of NIDDM," Diabetes Care 17, 1469-72 (1994); Diabetes Prevention Program Research Group, "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin," New Engl J Med 346, 393-403 (2002).

Chapter 9

"In his study of Spanish life in the 1960s . . ." See James Michener, Iberia (1968).

"In the film version the character of Bridget Jones is played by a conventionally slim actress . . ." Zellweger has since agreed to gain back the same 20 pounds for a sequel to the film. It was widely noted that she will be paid $100,000 per extra pound to play the role of a "fat" 129-pound woman.

"For obvious reasons advertisers and their clients -would like to condition men to become as neurotic about their appearance . . ." See "Holding Back the Years," Financial Times, August 16, 2003, p. 6.

"Recognizing the fundamental fraudulence of the -war on fat . . ." Brad Pitt has a reported BMI of 27.5, which puts him squarely in the middle of the "overweight" range, according to our public health authorities. Paltrow, on the other hand, has a BMI of 16, which correlates with a far higher degree of epidemiological risk than all but the most extreme levels of obesity.

Chapter 10

"Consider this passage from Roberta Seid's invaluable history . . ." Roberta Seid, Never Too Thin: Why Women Are at War with Their Bodies (1989), pp. 120-21.

"This is the theoretical mechanism behind the empirical fact that dieters often end up weighing more . . ." An article in the October 2003 issue of the medical journal Pediatrics reports that at any one time around a quarter of all American children between the ages of nine and fourteen report they are dieting, and that the dieting children gain more weight than children who report they do not diet. The authors speculate that this may be a product of either the slowing of the metabolism produced by chronic dieting, or binge behavior when the children find themselves unable to diet perpetually, or a combination of these factors.

" 'Someone needs to say that the emperor has no clothes,' says Wayne Callaway . . ." See Fraser, Losing It, p. 229.

"Do these researchers actually believe American culture is too tolerant toward fat?" As counterintuitive as this thesis might seem, it is put forth with increasing frequency in both the medical and popular literature. For a striking example, see Greg Critser's book Fat Land (2002), which argues that Americans are fat because, among other reasons, the media elites fail to convey to the masses that slimness is socially desirable. Or consider this quote from a prominent obesity researcher: "People don't realize that they're fat ... There are so many fat Americans now that it's sometimes the thin ones that are in the minority." Quoted in Saguy and Riley, "Fat Attack: Scientific and Political Debates over Obesity" (forthcoming).

"But let us take those crude statistics on their face." See the numerous epidemiological studies discussed in Chapter 1 for statistical breakdowns of the effects of "overweight" and "underweight" on life expectancy.

" 'Like cinema starlets who have only recently been manufactured . . .' " Frederick Exley, A Fan's Notes (1968), pp. 384-85.

Chapter 11

"According to the U.S. federal government, Marshall Faulk is obese." I calculated BMI figures for all of the league's more than 1,500 players by employing the statistics provided by the rosters of NFL teams, as listed on their official websites, in the summer of 2001.

"Indeed, some proponents of the BMI tables have begun to admit this indirectly . . ." See, for example, the National Institutes of Health website (www. nih.gov), which acknowledges that "some very muscular people may fall into the overweight category when they are actually healthy and fit." The public health establishment's manipulation of the BMI tables in this regard is essentially a verbal shell game. When confronted with the fact that many people who by every objective measure are in superb physical condition are also "overweight" and "obese" according to the BMI charts, public health officials admit that the charts are meaningless in such situations. Yet this admission is instantly forgotten when these same officials declare that, according to these same charts, nearly two-thirds of adult Americans are "overweight" and "obese."

"In their comprehensive review of the literature, Paul Ernsberger and Paul Haskew . . ." Ernsberger and Haskew, "Health Implications of Obesity: An Alternative View," J Obesity W Reg 6, 67 (1987).

"Yet only around 30 percent of the population qualifies for even this modest standard." This figure is a rough estimate, based on data from public health surveys, and studies such as those conducted by the Cooper Institute (cited in Chapter 1). One consequence of the fact that until recently the medical establishment took little notice of the importance of activity to health is that relatively little solid data exists regarding the activity levels of Americans, and how those levels relate to body mass.

"Wann sums up the principles of the nascent fat fitness movement . . ." Marilyn Wann, Fat!So? (1998), p. 61.

Chapter 12

"As Glenn Gaesser has put it, 'Of all our convictions about health . . .' "

"Perhaps the best evidence that people trying to lose weight are not motivated primarily by health concerns . . ."According to the Centers for Disease Control and Prevention, 70 percent of all "overweight" American women are attempting to lose weight at any particular time, as opposed to around 50 percent of "ideal weight" women. Significantly more women than men are dieting; the average American woman has a BMI of about 25; and rates of dieting peak around the age of forty. Thus the average American dieter is a middle-aged woman with a BMI in the mid-to-high 20s.

"A typical set of statistics from a large-scale epidemiological study . . ." Waaler et al., "Height, Weight and Mortality: The Norwegian Experience," Acta Med Scanda Suppl 679, 1-56 (1984).

"A few years ago, Esquire magazine conducted a survey . . ." Esquire, February 1994, p. 73.

"It becomes easier to understand that preference when considering such data as that provided by a recent university study . . ." See Texas Monthly, January 1997, p. 106.

Chapter 13

"Austin's web page makes it even clearer . . ." See www.secure.deniseaustin.com.

"Consider the classic symptoms of anorexia . . ." These descriptions are taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV).

"Despite a mass of epidemiological evidence that, in the words of one of the world's most eminent obesity experts . . ." Ancel Keys, Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease (1980).

"When someone such as Britney Spears . . ." Quoted in The Observer, September 16, 2001, p. 10.

"Over the course of the last century, what has been considered the ideal body weight for American women . . ." See, generally, Seid, Never Too Thin; Schwartz, Never Satisfied; Fraser, Losing It; Klein, Eat Fat; Chernin, The Obsession.

"By way of comparison, although today we remember flapper fashion as being focused on boyish thinness . . ." Seid, Never Too Thin, p. 97.

"Anyone familiar with what Naomi Wolf has characterized as 'the cult of dieting' . . ." Naomi Wolf's The Beauty Myth is an essential text for anyone who wishes to understand the ideological underpinnings and political consequences of America's weight obsession. Consider the following: "Dieting is the most potent political sedative in women's history; a quietly mad population is a tractable one."

"America's dieters, like Kafka's hunger artist . . ." See Kafka, Collected Stories (1993), p. 209.

Chapter 14

"For most people, the standard prescriptions for losing weight do not work . . ."

Some statistics on dieting patterns among contemporary Americans, from Serdula et al., "Prevalence of Attempting Weight Loss and Strategies for Controlling Weight,"JAMA 282, 1353-58 (1999). Among people with BMIs under 25, 8.6 percent of men and 28.7 percent of women are dieting. Among those with BMIs between 25 and 30, 35.7 percent of men and 59.6 percent of women are dieting. Among those with BMIs of 30 and higher, 60.4 percent of men and 70.1 percent of women are dieting. This is a snapshot of the percentages at a particular moment: The percentages of people who spend significant amounts of time dieting in each of these weight cohorts is undoubtedly much higher. Note that the percentage of dieters correlates very strongly with increasing weight, and that at any one time the vast majority of obese persons are dieting. It is clear that fatness causes dieting. It is also clear that dieting causes fatness. The denial of the second point may be the single most crucial feature of the obesity myth.

"Specifically, a growing number of obesity researchers, eating disorder specialists . . ." The Health at Every Size movement features a diverse group of proponents. Many of the leading figures have some association with the Healthy Weight Journal, a peer-reviewed medical journal, published by BL Decker, which in January 2004 was renamed Health at Every Size. The journal is edited by Jonathan Robison and Wayne Miller. Its editorial board includes Joanne Ikeda, Debby Burgard, Glenn Gaesser, Paul Ernsberger, Marilyn Wann, Karin Kratina, Patricia Lyons, Frances Berg, Lynn MacAfee, Lisa Tealer, and Karen Petersmarck. All these people have published extensively on the subject of weight and health, from a HAES point of view. The most comprehensive explanation and defense of the HAES approach is found in Gaesser's invaluable book Big Fat Lies (2002). Jon Robison maintains a website dedicated to HAES, which offers an excellent introduction to the subject, along with much bibliographical information. See www.jonrobison.net/size.html.

"The HAES movement itself is based on three core principles . . ." Robison, "Health at Every Size: Antidote for the Obesity Epidemic," Healthy Weight J 17(2) (2003).

"For instance, HAES proponents aim to publicize medical studies demonstrating that people who ingest exactly the same number of calories . . ." See

Bouchard et al., "The Response to Long-Term Overfeeding in Identical Twins" New Engl J Med 322, 1477-82 (1990).

"Similarly, a 1999 study published in Science . . ." Levine et al., "Role of Non-Exercise Activity Thermogenesis (NEAT) in Resistance to Fat Gain in Humans," Science 283, 212-14 (1999).

"The movement's seven 'principles for medical practice' are . . ." See Robison, cited above.

"As Glenn Gaesser points out . . ." Gaesser, Big Fat Lies, p. 83.

"For example, Linda Bacon, a nutrition researcher at the University of California-Davis . . ." Bacon et al., "Effects of Supporting 'Health at Every Size' and Intuitive Eating for Obese Female Chronic Dieters: A Randomized Clinical Trial," (forthcoming).

Chapter 15

"Three years later Chambrin revealed that he believed the first lady got rid of him because he was too fat . . ." Washington Times, September 9, 1997, p. A1. "According to Clinton's people, Chambrin was fired not because he was fat . . ."

Memphis Commercial Appeal, September 14, 1997, p. A7. "Indeed, a woman of considerably greater importance in Bill Clinton's life . . ."

Joyce Milton, The First Partner: Hillary Rodham Clinton (1999), p. 70. "In a touch straight out of Faulkner, the only person in Bill's immediate family . . ." The First Partner, p. 71. " 'Look, I want you to know that I've had it up to here with beauty queens . . .' "

The First Partner, p. 72. " 'This is fun. Women are throwing themselves at me.' " James B. Stewart, Blood Sport: The President and His Adversaries (1996), p. 70.

" 'It was such a sweet moment. It was the first time I had seen him without a shirt . . .' " Andrew Morton, Monica's Story (1999), p. 66.

" 'I saw you in the hall today—-you looked really skinny.' " Monica's Story, p. 72.

"Monica's teenage years were dominated by the devastation being a 'fat' girl at Beverly Hills High wrought . . ." Monica's Story, pp. 30-42.

" 'Her relationship with Andy [Blieler] was damaging to her . . ." Monica's Story, p. 49.

" 'She always saw herself as second best in her relationships with men . . .' "

"Twenty years older than Monica, Tripp had been teased mercilessly . . ." Monica's Story, pp. 92-93.

"Something else that has become clear with hindsight is that Tripp was obsessed with Bill Clinton . . ." Monica's Story, p. 95.

"It was at this juncture, in the fall of 1997, that the weight obsessions of two of the principal actors in the scandal . . ." Monica's Story, pp. 143-44.

"A 'fat cheesy slut'was one particularly vicious description . . ." The Star, October 10, 1998.

"Monica Lewinsky embodied, at a deep level of social anxiety, a sort of reincarnation of the rapacious, sexually insatiable Jewess . . ." For an interesting discussion of parallels between weight prejudice and anti-Semitism, see W. Charisse Goodman, The Invisible Woman: Confronting Weight Prejudice in America (1995).

Chapter 16

"The Lewinsky affair soon propelled her to the position of alpha female among a bevy of telegenic right-wing commentators . . ." For an amusing discussion of pundettes, see Michelle Cottle, "Washington Diarist," The New Republic, July 10, 2000, p. 48: "Most producers deny that appearance plays a big part in whom they book. This is a fib on the magnitude of 'I did not have sexual relations with that woman.'"

"In the words of another pundette, Heather Nauert . . ." Washington Post, May 25, 2000, p. C01.

All quotes attributed to Estrich are from Susan Estrich, Making the Case for Yourself: A Diet Book for Smart Women (1998).

"Third, remarkably for a self-identified feminist, Estrich never notes the obvious political implications of the common theme that links the times in her life when she was least able to diet . . ." In regard to the feminist literature which links dieting with gender oppression, Estrich comments: "I read all the popular books by beautiful feminists that were supposed to convince you that being slim and beautiful is just some sexist man's fantasy, but frankly, on me the books failed. They don't liberate me. I don't look in the mirror and smile at my stomach. I don't feel better about my body. I just feel vain, foolish, and stupid in addition to fat."

"At least Estrich admits that, in the context of what Naomi Wolf has termed the cult of dieting . . ." See, generally, Naomi Wolf, The Beauty Myth (1991).

"Coulter has even complained recently that she can't get a date . . ." The Guardian, May 17, 2003, p. 14.

Chapter 17

"Perhaps my favorite single example of how much of the work in this field is an embarrassment to the word 'science'. . ." Drenick et al., "Prolonged Starvation as Treatment for Severe Obesity," JAMA 187, 100-5 (1964).

"As two leading dissenters in the obesity research community have put it . . ."

Ernsberger and Haskew, "Health Implications of Obesity: An Alternative View," J Obesity W Reg 6, 67 (1987).

"As Karl Popper first pointed out more than seventy years ago . . ." Karl Popper, The Logic of Scientific Discovery (1959). Other classic discussions of this point include Thomas Kuhn, The Structure of Scientific Revolutions (1970), and Paul Feyerabend, Against Method (1993).

"I have yet to find a dress larger than size 12 . . ." I've been told that many fashionable boutiques in New York City do not carry any merchandise above size 8.

"Here again we have a social and economic puzzle: a group of retailers whose products fail completely to intersect with the needs of half the potential market . . ." See "Sizing Up the Marketplace," Chicago Sun Times, July 8, 2003, p. 40.

"Individual feminists, such as Naomi Wolf and Susan Bordo, have written devastating critiques . . ." See Naomi Wolf, The Beauty Myth (1991); Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body (1995).

"Such groups have been almost completely silent about the far greater levels of discrimination so-called obese women in particular face . . ." I am grateful to Abigail Saguy for pointing this out to me, and for helping me clarify my thinking on the complex issue of feminist organizations and fat discrimination.

"That is why much of the most powerful criticism of those ideals has not come from feminists in size 6 dresses . . ." See Marilyn Wann, Fat!So? (1998); Sondra Solovay, Tipping the Scales of Justice: Fighting Weight-Based Discrimination (2000); Carol Wiley (ed.), Journeys to Self-Acceptance: Fat Women Speak (1994). Jennifer Portnick is the San Francisco area aerobics instructor who brought a successful complaint under the city's nondiscrimination ordinance, against a Jazzercise health club franchise, for discriminating against her because of her weight. See San Francisco Chronicle, May 7, 2002, p. A1.

"The emotions fat elicits are fraught with the classic features produced by that which disgusts us . . ." See, generally, William Ian Miller, The Anatomy of Disgust (1997).

"In his famous essay 'Protestant Asceticism and the Spirit of Capitalism' . .

See Runciman, ed., Weber: Selections in Translation (1978), pp. 138-73.

"As Greg Critser notes, 'in upscale corporate America, being fat is a sure-fire career-killer.' " Greg Critser, "Let Them Eat Fat," Harper's, March 2000, p. 42.

" 'I hate to say it, but if you have this gene you can smoke and you can be fat . . .'" The New York Times, October 15, 2003, p. A16.

"Americans worry, with good reason, that we have become too big for our own good . . ." Cf. Tony Judt, "Anti-Americans Abroad," New York Review of Books, May 1, 2003: "If you want to understand how America appears to the world today, consider the sport-utility vehicle. Oversized and overweight, the SUV disdains negotiated agreements to restrict atmospheric pollution. It consumes inordinate quantities of scarce resources to furnish its privileged inhabitants with supererogatory services. It exposes outsiders to deadly risk in order to provide for the illusory security of its occupants. In a crowded world, the SUV appears as a dangerous anachro nism. Like U.S. foreign policy, the sport-utility vehicle comes packaged in sonorous mission statements; but underneath it is just an oversized pickup truck with too much power."

"As long ago as the 1950s, marketing analyst Victor Lebow pointed out . . ."

Quoted in Michael F. Jacobson and Laurie Ann Mazur, Marketing Madness: A Survival Guide for a Consumer Society (1995), p. 191.

"Indeed, as UCLA sociologist Abigail Saguy suggested to me . . ." Saguy has undertaken a long-term research project to study the social construction of "obesity" as a health and/or political issue in contemporary America. See, for example, Saguy and Riley, "Fat Attack: Scientific and Political Debates over Obesity" (forthcoming).

" 'Moral panic' is a term coined by Stanley Cohen in the 1960s . . ." See Stanley Cohen, Folk Devils and Moral Panics (2002).

"American history is rich with examples of moral panics." On the drug war, see Michael Massing, The Fix (2000). On sexual abuse in schools and day care centers, see Dorothy Rabinowitz, No Crueler Tyrannies: Accusation, False Witness, and Other Terrors of Our Times (2003). On McCarthyism, see Albert Fried, ed., The Great American Red Scare (1996). For a superb sociological analysis of various exaggerated and irrational fears in contemporary America, see Barry Glassner, The Culture of Fear: Why Americans Are Afraid of the Wrong Things (1999). Absurdly, apologists for the drug war, McCarthyism, etc., often insist their opponents are claiming that drugs are harmless, that there were no communist agents in the American government in the 1950s, and that there is no such thing as sexual abuse of preschool children. The parallel argument in the war on fat is the absurd assertion that those who question any aspect of that war are claiming that "obesity" is completely benign.

"Anorexia has a higher fatality rate than any other mental illness." The National Association of Anorexia and Associated Disorders estimates that the fatality rate from the syndrome may be as high as 15 percent—several times higher than that associated with major depression.

"In her pursuit of virtue, she becomes a secularized shadow of the so-called holy anorexics of premodern Europe . . ." See Rudolph M. Bell, Holy Anorexia (1987).

Chapter 18

"Near the end of his essay 'Why I Write' George Orwell . . ." Ian Angus and Sonia Orwell, eds., George Orwell: An Age Like This 1920-1940: The Collected Essays, Journalism & Letters (1968), p. 3.

"When I began to write this book I was fat." As Abigail Saguy and Kevin Riley point out, a routine tactic of the war on fat involves referring to the bodies of the opponents of that war in order to discredit those opponents: "Obesity researchers [are] more likely to evoke the bodies of fat acceptance activists to discredit them than to do this for Health At Every Size scholars, partly because many leading HAES scholars ... are thin men. In fact, Glenn Gaesser said in an interview that his book editor only agreed to publish Big Fat Lies when she saw that he was tall and thin because she reasoned that, if he had been fat, the book 'would have been viewed as almost a rationalization for being fat, [as if he had] a personal axe to grind.' [By contrast] most fat activists are women who would be categorized as morbidly obese. In interviews, obesity researchers suggested that this fact . . . discredited them as simply making excuses for their weight. That a fat person is incapable of speaking objectively about weight seems to be readily accepted, while the idea that a thin person would be biased in a different but equally strong direction seems to be less intuitive. In this case, thinness functions as an 'unmarked category,' much as whiteness or maleness are considered unmarked categories for race and gender, respectively. In all of these cases, the biases of the dominant group are ignored." Saguy and Riley, "Fat Attack: Scientific and Political Debates over Obesity" (forthcoming).

This perceptive analysis implies that the ideal of interpretive objectivity may be even less attainable in the context of a psychologically and politically fraught issue such as weight than it is in regard to most other medical and public health controversies. It follows that, while there is nothing necessarily illegitimate about suggesting that many fat activists hold the views they do, in part, because they are fat, it is also legitimate to suggest that many people who are actively involved in prosecuting the war on fat do so, in part, because of psychological investments they

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